Peroral video cholangioscopy to evaluate indeterminate bile duct lesions and preoperative mucosal cancerous extension: a prospective multicenter study

Background and study aims: Despite the development of peroral video cholangioscopy (PVCS), no prospective multicenter studies have been undertaken to investigate the diagnostic accuracy of PVCS in biliary tract diseases. Therefore, the aim of this study was to clarify the accuracy of PVCS in evaluating biliary tract lesions.

Patients and methods: This study was a prospective multicenter study at five tertiary referral centers in Japan and included 87 eligible patients with biliary tract diseases who underwent PVCS. The study evaluated the ability of PVCS to diagnose indeterminate biliary tract diseases, detect mucosal cancerous extension preoperatively in extrahepatic bile duct cancers, and predict adverse events.

Results: The use of PVCS appearance alone correctly distinguished benign from malignant indeterminate biliary lesions in 92.1 % of patients whereas biopsy alone was accurate in 85.7 %. In extrahepatic bile duct cancer, mucosal cancer extended histologically at least 20 mm in 34.7 % (17/49) of patients. The accuracy rate of PVCS to evaluate the presence or absence of mucosal cancerous extension by endoscopic retrograde cholangiography (ERC) alone, ERC with PVCS, and ERC with PVCS + biopsy were 73.5 %, 83.7 %, and 92.9 %, respectively. Adverse events were seen in 6.9 % of PVCS patients, but no serious complications were observed.

Conclusion: PVCS enhanced the accurate diagnosis of biliary tract lesions by providing excellent resolution in combination with biopsy.

• References

• 1 Nakajima M, Akasaka Y, Fukumoto K et al. Peroral cholangiopancreatoscopy (PCPS) under duodenoscopic guidance. Am J Gastroenterol 1976; 66: 241-247
• 2 Rösch W, Koch H, Demling L. Peroral cholangioscopy. Endoscopy 1976; 8: 172-175
• 3 Kozarek R. Direct cholangioscopy and pancreatoscopy at time of endoscopic retrograde cholangiopancreatography. Am J Gastroentrol 1988; 83: 55-57
• 4 Fukuda Y, Tsuyuguchi T, Sakai Y et al. Diagnostic utility of peroral cholangioscopy for various bile duct lesions. Gastrointest Endosc 2005; 62: 374-382
• 5 Awadallah NS, Chen YK, Piraka C et al. Is there a role for cholangioscopy in patients with primary sclerosing cholangitis?. Am J Gastroenterol 2006; 101: 284-291
• 6 Chen YK, Pleskow DK. Spyglass single-operator peroral cholangiopancreatoscopy system for the diagnosis and therapy of bile-duct disorders: a clinical feasibility study (with video). Gastrointest Endosc 2007; 65: 832-841
• 7 Igarashi Y, Okano N, Sato D et al. Peroral cholangioscopy using a new thinner videoscope (CHF-B260). Dig Endosc 2005; 17: 63-S66
• 8 Itoi T, Sofuni A, Itokawa F et al. Peroral cholangioscopic diagnosis of biliary tract diseases using narrow-band imaging. Gastrointest Endosc 2007; 66: 730-736
• 9 Itoi T, Neuhaus H, Chen YK. Diagnostic value of imaging-enhanced video cholangiopancreatoscopy. Gastrointest Endosc Clin N Am 2009; 19: 557-566
• 10 Kawakami H, Kuwatani M, Etoh K et al. Endoscopic retrograde cholangiography versus peroral cholangioscopy to evaluate intraepithelial tumor spread in biliary cancer. Endoscopy 2009; 41: 959-964
• 11 Itoi T, Sofuni A, Itokawa F et al. Evaluation of peroral videocholangioscopy using narrow-band imaging for diagnosis of intraductal papillary neoplasm of the bile duct. Dig Endosc 2009; 21: 103-S107
• 12 Ueki T, Mizuno M, Ota S et al. Carbon dioxide insufflation is useful for obtaining clear images of the bile duct during peroral cholangioscopy (with video). Gastrointest Endosc 2010; 71: 1046-1051
• 13 Itoi T, Osanai M, Igarashi Y et al. Diagnostic peroral video cholangioscopy is an accurate diagnostic tool for patients with bile duct lesions. Clin Gastroenterol Hepatol 2010; 8: 934-938
• 14 Doi S, Yasuda I, Nakashima M et al. Carbon dioxide insufflation vs. conventional saline irrigation for peroral video cholangioscopy. Endoscopy 2011; 43: 1070-1075
• 15 Cotton PB, Lehman G, Vennes J et al. Endoscopic sphincterotomy complications and their management: an attempt at consensus. Gastrointest Endosc 1991; 37: 383-393
• 16 Nimura Y, Kamiya J, Hayakawa N et al. Cholangioscopic differentiation of biliary strictures and polyps. Endoscopy 1989; 21: 351-356
• 17 Sato M, Inoue H, Ogawa S et al. Limitation of percutaneous transhepatic cholangioscopy for the diagnosis of the intramural extension of bile duct carcinoma. Endoscopy 1998; 30: 281-288
• 18 Neuhaus H. Cholangioscopy. Endoscopy 1994; 26: 120-125
• 19 Seo DW, Lee SK, Yoo KS et al. Cholangioscopic findings in the bile duct tumors. Gastrointest Endosc 2000; 52: 630-634
• 20 Nakanishi Y, Zen Y, Kawakami H et al. Extrahepatic bile duct carcinoma with extensive intraepithelial spread: a clinicopathological study of 21 cases. Mod Pathol 2008; 21: 807-816
• 21 Igami T, Nagino M, Oda K et al. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg 2009; 249: 296-302
• 22 Bosman F, Carneiro F, Hruban R et al. WHO classification of tumours of the digestive system. 4th. edn. Lyon, France: IARC Press; 2010
• 23 Shah RJ, Langer DA, Antillon MR et al. Cholangioscopy and cholangioscopic forceps biopsy in patients with indeterminate pancreaticobiliary pathology. Clin Gastroenterol Hepatol 2006; 4: 219-225
• 24 Draganov PV, Lin T, Chauhan S et al. Prospective evaluation of the clinical utility of ERCP-guided cholangiopancreatoscopy with a new direct visualization system. Gastrointest Endosc 2011; 73: 971-979
• 25 Ramchandani M, Reddy DN, Gupta R et al. Role of single-operator peroral cholangioscopy in the diagnosis of indeterminate biliary lesions: a single-center, prospective study. Gastrointest Endosc 2011; 74: 511-519
• 26 Chen YK, Parsi MA, Binmoeller KF et al. Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos). Gastrointest Endosc 2011; 74: 805-814
• 27 Draganov PV, Chauhan S, Wagh MS et al. Diagnostic accuracy of conventional and cholangioscopy-guided sampling of indeterminate biliary lesions at the time of ERCP: a prospective, long-term follow-up study. Gastrointest Endosc 2012; 75: 347-353
• 28 Kubota Y, Takaoka M, Tani K et al. Endoscopic transpapillary biopsy for diagnosis of patients with pancreaticobiliary ductal strictures. Am J Gastroenterol 1993; 88: 1700-1704
• 29 Sugiyama M, Atomi Y, Wada N et al. Endoscopic transpapillary bile duct biopsy without sphincterotomy for diagnosing biliary strictures: a prospective comparative study with bile and brush cytology. Am J Gastroenterol 1996; 91: 465-467
• 30 Tamada K, Tomiyama T, Wada S et al. Endoscopic transpapillary bile duct biopsy with the combination of intraductal ultrasonography in the diagnosis of biliary strictures. Gut 2002; 50: 326-331
• 31 ASGE Technology Committee. Shah RJ, Adler DG et al. Cholangiopancreatoscopy. Gastrointest Endosc 2008; 68: 411-421
• 32 Sethi A, Chen YK, Austin GL et al. ERCP with cholangiopancreatoscopy may be associated with higher rates of complications than ERCP alone: a single-center experience. Gastrointest Endosc 2011; 73: 251-256